Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open. 2020 Nov 4;10(11):e038406. doi: 10.1136/bmjopen-2020-038406.

Abstract

Objectives: This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.

Design: Interview-based study using Constructivist Grounded Theory methodology.

Setting: This study was conducted in multiple team contexts at one of Canada's largest acute-care teaching hospitals.

Participants: 25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.

Intervention: Not relevant due to the qualitative nature of the study.

Primary and secondary outcome: Not relevant due to the qualitative nature of the study.

Results: The dataset was analysed using the sensitising concept of 'traces' from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.

Conclusions: This study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

Keywords: medical education & training; qualitative research; quality in health care.